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General Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

ACS | Investigations
DDx high troponin
ECG changes

A

Troponin; repeat after 6hrs, in 1000s
DDx: pericarditis, myocarditis, arrhythmias, PE

ECG; STEMI, new LBBB, pathological Q waves, T wave inversion/flattening/elevation

CXR to look for cardiomegaly, pulmonary oedema, widened mediastinum (aortic rupture)

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2
Q

Chest pain | Differentials
Cardiac
Non-cardiac

A 
[Cardiac]
ACS; nausea/vomiting, sweating, SOB, occurring at rest
Stable angina; exertional
Aortic dissection
Pericarditis/cardiac tamponade
Myocarditis
Acute CCF
Arrhythmias

[Respiratory]
PE

[Other]
Acute pancreatitis
Oesphageal rupture
GORD/PUD
Oesphagitis/oesphageal spasm
Acute cholecystitis
Rib #
Costochondritis
Anxiety
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3
Q

ACS | Management
Acute, MONAC
Secondary prevention

Modifiable risk factors
General advice

A 
[Acute]
(Oxygen, if hypoxic)
Sublingual GTN
IV morphine
Aspirin 300mg
Revascularisation with PCI <90mins
Or thrombolysis >90mins and transfer to primary PCI centre

[Secondary prevention]
Modifiable risk factors

Dual antiplatelet therapy
Aspirin + clopidogrel 12/12
Beta-blocker; bisoprolol 12/12
ACEi lifelong; ramipril
Statin lifelong; atorvastatin
[General advice]
Cardiac rehab
Work
Driving
Diet
Exercise
Sex
Travel
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4
Q 
Arrhythmias | Management
AF/flutter
SVT
VT
1st degree/Mobitz type I AV block
2nd/3rd degree AV block

Ectopics
Torsades de pointes

A

[AF/flutter]
Rate control; >48hrs
Rhythm control; young, new onset, electrolyte imbalance
<48hrs either option
>48hrs rate, must be fully anticoagulated before cardioversion, echo to r/o atrial thrombus

[Rate]
Bisoprolol
Digoxin; sedentary patients
Verapamil
OR
[Rhythm]
Amiodarone (less effective in flutter)
DC cardioversion

Anticoagulate CHADSVASC vs. HASBLED
M > 1, offer
F > 2, offer

[SVT]
Carotid sinus massage
Valsalva manoeuvre 
Adenosine
(Flecainide; structural heart disease)

[VT] Amiodarone IV
DC shock

Heart block
[1st/MT I] Atropine
[2nd/3rd] Pacemaker (Ventricular)

[Ectopics] Observe, if symptomatic amiodarone

[TDP] Magnesium sulfate
(Hypokalaemia)

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5
Q

HF | Aetiology & Investigations

RHF
LHF

A

RHF; LVF, lung disease, pulmonary stenosis
Systemic peripheral oedema, ascites, raised JVP, pHTN

LHF; Pulmonary oedema, SOB, reduced ET, fatigue, orthopnoea, PND, wheeze, nocturnal cough pinky frothy sputum, weight loss, cachexia

BNP
ECG; may suggest cause, ischaemia, ventricular hypertrophy
CXR; Alveolar oedema, kerley B lines, Cardiomegaly, Dilated upper lobe vessels/diversion, pleural Effusion
Echocardiogram

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6
Q

HF | Management
Acute; pulmonary oedema ‘LMNOP’
Chronic

NYHA
I; asymptomatic
II; SOB on exertion
III; SOB on minor exertion
IV; SOB at rest
A 
[Acute]
LVF/MR from post-MI/IHD
(Oxygen if hypoxic)
Morphine
Furosemide
GTN/isosorbide mononitrate
[Chronic]
Furosemide/bumetanide
ACEi
Beta-blocker
(Spironolactone)
(Digoxin)
(Isosorbide mononitrate)

Salt and fluid restrict 1.5L/day
Daily weights, U&Es
DVT prophylaxis

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7
Q

HTN | Investigations, Aetiology & Target BP

Hypertensive retinopathy

A

24hr ambulatory BP monitoring (ABPM)
1/52 home BP readings
3x clinic readings

[Aetiology]
Renal disease; GN, vasculitis, PKD
Endocrine; Cushing’s, Conn’s, phaechromocytoma, hyperparathyroidism
Pregnancy, OCP

Consider treating >140/90, calculate CV risk and look for organ damage

Treat all with >160/100
>180/110 treat immediately

Malignant HTN >200/130
(Headache, visual disturbance, papilloedema)

[Target BP] <140/90
Age >80yrs 150/90
DM <130/80

[Hypertensive retinopathy]

  1. Tortuous arteries with ‘silver wiring’
  2. AV nipping
  3. Flame haemorrhages, cotton-wool spots
  4. Papilloedema
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8
Q

HTN | Management

Malignant HTN

A

[Caucasian <55yrs]
ACEi/ARB
A+C
A+C+D

[Afro-carribbean, >55yrs]
CCB (nifedipine)
Or thiazide diuretic

[Malignant HTN]
PO atenolol
IV labetalol

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9
Q

Rheumatic Fever | Symptoms & Management

Group A beta-haemolytic streptococcal infection
Complication strep throat or scarlet fever

60% develop chronic rheumatic heart disease

A

[Symptoms] Criteria
Major; carditis, arthritis, rash, chorea
Minor; fever, raised ESR/CRP, arthralgia, prolonged PR interval, previous rheumatic fever

Tx; IV benzylpenicillin, PO phenoxymethylpenicillin
Aspirin, NSAIDs, prednisolone
Haloperidol, diazepam

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10
Q

Mitral Regurgitation | Clinical features, Aetiology & Investigations

Symptoms
Signs
ECG
CXR

Mitral Stenosis has similar findings

A 
[Aetiology]
LV dilatation
Rheumatic fever, infective endocarditis
Post-MI; papillary/chordae tendinae rupture
CTD; Ehlers-Danlos, Marfan's

Symptoms; SOB, palpitations, fatigue

Signs; AF, displaced heaving apex, pansystolic murmur at apex radiating to axilla

ECG; P-mitrale (LA hypertrophy), LVH, AF
CXR; pulmonary oedema, LA/LV enlargement

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11
Q

Aortic Stenosis | Clinical presentation & Management

Triad
Signs

ECG

A

Elderly person with chest pain, SOBOE, syncope
Triad; angina, syncope, HF
Signs; slow-rising pulse, narrow pulse pressure, heaving non-displaced apex, LV heave, aortic thrill, ejection-systolic murmur at LSE and aortic area radiating to carotids

ECG; LVH, P-mitrale, LBBB, AV block

Tx; valve replacement

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12
Q 
Aortic Regurgitation | Clinical features
Symptoms
Signs
ECG
CXR
A

Symptoms; SOBOE, orthopnoea, PND, palpitations, angina, syncope, CCF
Signs; collapsing (water hammer) pulse, wide pulse pressure, displaced apex beat, early diastolic murmur expiration sat forward, carotid pulsation, head nodding with each heartbeat, capillary pulsation in nailbeds

ECG; LVH
CXR; cardiomegaly, pulmonary oedema

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13
Q

Infective endocarditis | Clinical features, Investigations & Management

Signs
Diagnosis
ECG
CXR

A

Fever + new murmur
Strep. viridans, Staph. aureus (IVDU)

Signs; anaemia, splenomegaly, clubbing, new/changed murmur, systemic emboli

[Diagnosis]
Modified Duke criteria

[Investigations]
3x positive blood cultures at 3 different sites
Normochromic normocytic anaemia
Urinalysis; microscopic haematuria
ECG; AV block
Echo; vegetations
CT; to look for emboli (spleen, brain)

[Management]
Empirical; ampicillin, flucloxacillin, gentamicin
Staph; flucloxacillin
Strep; benzylpencillin

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14
Q

Pericarditis | Clinical features, Investigation & Management
Aetiology

A

[Aetiology]
Viruses; Coxsackie virus, EBV, CMV, HIV
Bacteria; TB, pneumonia, Staph, Strep
Systemic autoimmune diseases; vasculitides, IBD, sarcoidosis

[Clinical features]
Chest pain worse on inspiration or lying flat, relieved by sitting forward
Pericardial friction rub
Pericardial effusion
Cardiac tamponade; pulsus paradoxus
Fever

[Investigations]
ECG; saddle-shaped ST segment, PR depression, widespread ST elevation
Raised troponin
CXR; cardiomegaly, pericardial effusion

Tx; NSAIDs/aspirin + PPI for 1-2/52
Prophylactic colchicine 3/12

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15
Q

Cardiac Tamponade | Clinical features & Management

A

Beck’s triad; low BP, rising JVP, muffled heart sounds

Tx; pericardiocentesis

Send fluid for culture and cytology

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16
Q 
The DVLA | Driving Restrictions
Angina
Angioplasty
Dysrhythmias
Pacemaker
Syncope
TIA/stroke
LOC
Epilepsy
A

Angina; cease if sx at rest or with emotion
Angioplasty; cease 1/52
MI; cease 1/52 if angioplasty, 4/52 if not
Dysrhythmias; cease if likely to cause incapacity, recommence 4/52 after control
Pacemaker; cease 1/52, MUST notify DVLA
Syncope; unexplained likely cardiac cause, cease 4/52 until cause identified, otherwise cease 6/12

TIA/stroke; cease 1/12, MUST notify if VISUAL field defect

LOC; unidentified cause cease 6/12
Epilepsy; seizure in last 5yrs whilst awake cease 1yr, if consciousness unaffected/occurs in sleep NO restriction

Visual disability; in BOTH eyes, MUST notify DVLA

17
Q

Aortic dissection | Overview

Types
Clinical features of distal extension

A

Type A; Ao valve, Ao arch, ascending aorta proximal to left subclavian a.
I; extends to abdominal Ao
II; localised to ascending Ao

Type B; descending aorta distal to left subclavian a.

[Clinical features]

Distal extension; AKI, limb/visceral ischaemia, absent pulses, neurological deficit hemiplegia

18
Q

Anticoagulation | Arterial vs Venous

Antiplatelets; aspirin, clopidogrel, ticagrelor
Anticoagulants; warfarin, DOACs, heparin, LMWH
Fibrinolytics; altepase, streptokinase

Anti-embolism stockings

Treatment

A

Arterial thrombi; platelet rich, little fibrin
Venous thrombi; fibrin rich, few platelets

[Arterial]
Acute; anticoagulants
Chronic; antiplatelets

[Venous]
Acute; fibrinolytics
Chronic; anticoagulants

Warfarin/DOAC; 48-72hrs for full effect

Heparin/LMWH; immediate effect

19
Q

Limb ischaemia | Overview

Acute vs. Critical

A

Acute worse than critical

[Acute limb ischaemia]
6x P’s
Emergency

[Critical limb ischaemia]
'Ischaemic rest pain'
Pain at rest for >2/52
Often at night, when gravity works against circulation in legs
Not improved with analgesia
Pale/cold leg
With weak/absent pulses
ABPI <0.5

Smoking biggest RF

[Aetiology]
Atherosclerosis
Embolism
Functional; vasospasm

[Management]
Lifestyle modifications
Statins
Antiplatelets
Anticoagulants
20
Q

Stable angina | Management

A

Acute attacks; sublingual GTN spray

Ongoing; beta-blocker or CCB

  1. Bisprolol/amlodipine
  2. Switch to the other or combine B + C
    • isosorbide mononitrate/ivabradine/nicorandil/ranolazine

General Medicine (7 decks)

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